Gary R Crosby, O.D.
Individual provider Active NPI Optometrist · Macomb, IL
NPI 1124134747 · NPPES record last updated May 8, 2008
Key facts
- NPI
- 1124134747
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 046006389 (IL)
- Practice address
- 820 E Jackson St
Macomb, IL 61455-2412 - Phone
- (309) 833-4242
- Fax
- (309) 833-3597
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046006389 | IL | Yes |
Addresses
Primary practice location
820 E Jackson St
Macomb, IL 61455-2412
Mailing address
820 E Jackson St
Macomb, IL 61455-2412
Phone (309) 833-4242
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005584004 | Other | IL | BLUE CROSS BLUE SHIELD |
| 046006389 | Medicaid | IL |
Other providers in Macomb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.